Lions Fellowships and Memberships Order Form

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Select the type of fellowship or membership:

Quantity

Name of recipient as it will appear

Language for Fellowship or Membership

English
French

Presentation Date (if known)

Lions Club District (if applicable)

Contact person

Full name

First

Last

Address

Adresse ligne 1

Adresse ligne 2

Ville

État / Province / Région

Code postal

Pays

Phone Number

Comments

Payment Information

Total

$0.00

Method of payment

Credit card
Cheque
Other

Credit Card

Paragraph Text

For Cheques: Make cheques payable to: Lions Foundation of Canada Dog Guides. Please send your payment to: Lions Foundation of Canada Dog Guides Att: Memorial Forest. 152 Wilson St., Oakville, L6K 0G6